Double breaded island flap urethroplasty

Double bun island flap urethroplasty for the treatment of hypospadias. Hypospadias is a congenital malformation more common in pediatric genitourinary system. At the 5th week of the embryo, the tissues on both sides of the front of the cloaca are forwarded, producing two reproductive nodules. The reproductive nodules grow rapidly, and the urogenital sinus elongates, forming a longitudinal line on the ventral side of the reproductive nodules. The long groove, the urethral groove, closes from the posterior to the uterus as the fetus develops. In the development process, there are obstacles, and the urethral groove can not be completely closed to the tip of the penis head, which causes partial cracking and formation of hypospadias. Curing disease: Indication All types of congenital hypospadias should be treated with hypospadias. Preoperative preparation 1. On the 1st day before surgery, the skin of the field is disinfected with 1:500 benzalkonium solution or 75% ethanol. The urethra was infused with 1:2000 benzalkonium solution 2 to 3 ml to disinfect the urethra. 2, preparation of blood 200 ~ 400ml. 3. Apply antibiotics. 4. Clean the enema. Surgical procedure 1. Make a circular incision around the outer urethra of the urethra, extend it to the outside of the head, and make a circular incision around the head 0.5 cm from the ligament, then straighten the foreskin on the back side, and make a width of 5 cm at the inner layer of the foreskin. 2 km long skin island. 2. After the inner plate is inverted inward, the 5-0 chrome gut is intermittently sutured to form a tubular shape, but the subcutaneous tissue between the outer plate and the inner plate is not separated. Cut along the outer skin of the foreskin, the incision is 2 cm away from the urethral tube. 3. Free the pedicle of the skin island, be careful not to damage the blood vessels in the pedicle. The free length is such that the formed urethra and the skin island on the surface thereof can be smoothly transferred to the ventral side. 4. Transfer the formed urethra together with the free pedicled sheath to the ventral side of the penis, so that the outer sheath of the foreskin covers the surface of the formed urethra. 5. Make a tunnel from the proximal end of the ventral side of the penis to the cavernous body, and reach the normal urethral opening position at the tip of the penis head, so that the formed urethra can make a stoma at the tip of the penis head through the tunnel. 6. The newly formed distal end of the urethra is pulled out from the tunnel, and the proximal end and the external urethra are anastomosed with a 5-0 chrome gut or a 5-0 synthetic absorbable suture for 1 week; the distal new urethra is formed. The incision of the outer mouth and the head is also intermittently anastomosed with the same material, and then the skin transferred to the ventral side of the penis is sutured intermittently with the skin of the penis. complication 1, bleeding After the urethral sponge or the penis leucorrhea is cut, if the suture is not sutured, hemorrhage may occur when the penis is erected. When the compression is used, the wound must be opened to remove the hematoma and suture to stop bleeding. 2, infection Especially on the basis of bleeding and hematoma, infection is more likely to occur. 3, necrosis When the tension of the suture is too large, it may cause cracking and partial necrosis. Therefore, if the tension is too large after suturing, the dorsal incision should be made.